tbuckley/cabot-search huggingface dataset:
Tumor-infiltrating lymphocytes (TILs) dynamics in breast cancer patients receiving neoadjuvant therapy: A systematic review and meta-analysis.
Authors: Ioannis Zerdes, Yajing Zhu, Evangelos Tzoras, Alexios Matikas, Jonas C. S. Bergh, Antonios Valachis, Theodoros Foukakis
Journal: Journal of Clinical Oncology (2022)

e12620 Background: Increased baseline tumor-infiltrating lymphocytes (TILs) are associated with improved pathological complete response rates and better prognosis in HER2+ and triple negative breast cancer (TNBC) patients receiving neoadjuvant therapy (NAT). However, the role of TILs dynamics/change (ΔTILs) at the neoadjuvant setting remains unclear, thus a meta-analysis of the published studies was carried out. Methods: Medline, Embase, Cochrane Library and Web of Science Core Collection were searched for studies reporting on TILs expression in paired invasive breast cancer patient tissue samples before and after NAT. Data were extracted by two investigators (Y.Z., E.T.) and discordances were resolved by a third (I.Z.). Outcomes included pooled TILs rates pre- &amp; post-treatment (also per subtype), pooled rates of ΔTILs and direction of change after NAT as well as correlation of ΔTILs with survival outcomes. Heterogeneity was assessed using the I 2 statistic. Results: Of 1569 identified entries, 22 studies fulfilled the criteria and provided adequate data for the outcomes of interest. Overall, a significantly decreased level of TILs was observed after NAT in paired samples (pooled OR = 1.60, 95% CI: 1.12-2.30, p = 0.01; TILs as categorical variable). Regarding pooled rates of ΔTILs, a change was observed after NAT, irrespective of BC subtype. Among the different subtypes, the effect of NAT on TILs was most prominent in HER2+ disease with a direction towards decreased TILs to be more common (pooled ΔTILs rates: 14.4% increased vs 46.2%, decreased). In TNBC, bi-directional TIL kinetics were noted (pooled ΔTILs rates: 41.6% increased vs 37.1% decreased). An increase in ΔTILs in TNBC was associated with better disease-free/relapse-free survival in univariate analysis (HR = 0.59, 95% CI: 0.37–0.95, p = 0.03). Substantial between-study heterogeneity was observed in most analyses. Conclusions: The first to our knowledge meta-analysis on TILs dynamics during NAT in BC informs about differences in matched pre- and post-treatment patient samples and the prognostic implications of ΔTILs in TNBC. The potential clinical utility of the longitudinal assessment of immune response during neoadjuvant therapy warrants further investigation in prospective trials.
Racial and socioeconomic disparities in telemedicine use among US patients initiating cancer treatment during the COVID-19 pandemic.
Authors: Jenny Guadamuz, Xiaoliang Wang, Trevor Joseph Royce, Gregory Sampang Calip
Journal: Journal of Clinical Oncology (2022)

6511 Background: The COVID-19 pandemic was associated with declines in in-person clinical visits. While telemedicine visits have increased, uptake has varied. Here we assess demographic and socioeconomic factors associated with telemedicine use among patients initiating treatment for 21 common cancers at community oncology clinics. Methods: This retrospective study uses the nationwide Flatiron Health electronic health record-derived de-identified database of patients with cancer. Patient characteristics were determined using structured and unstructured data curated via technology-enabled abstraction. We included patients (≥ 18 years) who initiated first-line cancer treatment between March 2020 and September 2021 (follow-up through December 2021). We focused on differences in telemedicine use (≥ 1 telemedicine visit within 90 days after treatment initiation) across race/ethnicity, insurance coverage, rurality (per Rural-Urban Commuting Areas), and socioeconomic status (SES). SES was defined using census block group data from the American Community Survey (2015-2019) (quintiles representing least to most affluent areas) based on patient addresses and measured using the Yost Index (incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information). We used logistic regression models adjusted for clinical characteristics ( i.e., age, sex, performance status, and stage) to examine differences in telemedicine use. Results: This study included 24,164 patients (48.1% women, median age: 69 [interquartile range: 61-77] years), of whom 15.9% used telemedicine services. Black patients were less likely to use telemedicine services than White patients (11.4% vs. 15.6%, odds ratio [OR] 0.69 [95% confidence interval [CI]: 0.59-0.79], p&lt;0.01). Telemedicine use was also lower among patients without documented insurance than well-insured (commercial and Medicare payers) patients (10.7% vs. 15.9%, OR 0.62 [95% CI: 0.54-0.72], p&lt;0.01). Those in rural (9.8%, OR 0.51 [95% CI: 0.45-0.58], p&lt;0.01) and suburban areas (13.1%, OR 0.71 [95%: 0.64-0.79], p&lt;0.01) were less likely to use telemedicine services than patients in urban areas (17.6%). Finally, patients in the least affluent areas had lower telemedicine use than those in the most affluent areas (10.2% vs. 24.3%, OR 0.35 [95% CI: 0.31-0.40], p&lt;0.01). Conclusions: During the COVID-19 pandemic, nearly one-fifth of patients initiating cancer treatment used telemedicine services. However, there were substantial disparities: Black, uninsured, non-urban, and less affluent patients are less likely to use telemedicine services. While telemedicine may expand access to specialty care, the proliferation of these services may widen cancer care disparities if vulnerable populations do not have equitable access.
PD-L1 expression and microsatellite instability in tumors of unknown primary site.
Authors: Joao Neif, Maria Lazarini, Murilo Bonatelli, Gustavo Noriz Berardinelli, Daniel D Almeida Preto, Hadson Silva Araujo, Vinicius Duval da Silva, Celine Marques Pinheiro, Rui Manuel Reis, Flavio Mavignier Carcano
Journal: Journal of Clinical Oncology (2022)

2635 Background: Cancer of unknown primary site is a heterogeneous group of tumors for which the origin remains unknown, despite detailed investigation. Its clinical presentation occurs due to symptoms resulting from metastasis, which can be influenced not only by biological processes of the tumor, but also due to regulatory processes in the tumor microenvironment such as PD-L1. Microsatellite instability (MSI) is a predictive biomarker for cancer immunotherapy and its status as well as co-occurrence with PD-L1 expression is poorly evaluated. The aim of this study was to evaluate the expression of PD-L1 and the status of MSI in tumors of unknown primary site and their possible associations with clinical-pathological characteristics and clinical outcomes in patients with this type of tumor. Methods: The PD-L1 expression was evaluated using the immunohistochemistry technique and measured by CPS and TPS scores. MSI status was assessed using a hexa-plex marker panel by polymerase chain reaction followed by fragment analysis. Overall survival was analyzed using the Kaplan Meier method and comparisons of the curves using the log rank test. Results: Of the 121 conclusive cases for MSI status, only two cases (1,6%) were MSI-High. PD-L1 expression, assessed by both TPS and CPS, was positive in approximately 18% of 108 conclusive cases. PD-L1 expression is significantly less frequent in patients with a predominance of hepatic or bone metastasis and more frequent in patients with a predominance of nodal metastasis. The median overall survival was about 4 months, and the predominance of liver metastases was associated with a worse prognosis, while the use of chemotherapy and low ECOG-PS were associated with better survival. PD-L1 expression was associated with better overall survival. Conclusions: PD-L1 is expressed in a subset of patients with cancer of unknown primary site, while MSI is a rare event. It is necessary to better explore the microenvironment of this type of tumor as well as the role of immunotherapy to change such a dismal clinical outcome.
The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis
Authors: Gergő Baranyi, Seena Fazel, Sabine Delhey Langerfeldt, Adrian P Mundt
Journal: The Lancet Public Health (2022)

Comorbid mental illnesses and substance use disorders are associated with adverse criminal, social, and health outcomes. Yet, their burden is not reliably known among prison populations. We therefore aimed to estimate the prevalence of comorbid serious mental illnesses and substance use disorders (dual disorders) among people in prison worldwide.
COVID vaccine immune response in patients with plasma cell dyscrasia: A systematic review.
Authors: Unaiza Faizan, Lakshmi G. Nair, James Evans, Faiz Anwer
Journal: Journal of Clinical Oncology (2022)

8067 Background: The defective immune system in plasma cell dyscrasia places patients at a higher risk of developing a severe infection, which is one of the leading causes of death in such patients. In an era of a global pandemic, it is essential to protect them against COVID-19, but fewer effective plasma cells lead to a suboptimal response to vaccines. There is still a lack of evidence whether the seroconversion is truly clinically relevant and if patients with plasma cell disorders would benefit from frequent boosters to maintain antibody levels. Methods: Online databases including PubMed, CINAHL, Ovid, and Cochrane were searched (January 11th, 2022), following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Only articles published in the English language were included. Abstracts, case reports, and case series were excluded. Out of 40 studies, 5 articles were selected for a systematic review. Results: In all 5 studies (N=654), seroconversion post-vaccination was used as a positive response to COVID-19 vaccination. Although patients with plasma cell disorders had a lower seroconversion rate compared to controls, the overall percentage was substantial and ranged between 23-95.5%. Amongst patients on active therapy, lower seroconversion rates were seen in patients on a CD-38 inhibitor, ranging from 20.2-92.1% (N=174). Also, a significantly lower percentage was recorded in patients above 65 years and those who have been treated with multiple therapies previously. Better seroconversion rates were seen in mRNA vaccines compared to J&amp;J. Conclusions: Variable seropositive rates are seen in patients with plasma cell dyscrasias, lower rates are reported in patients on active therapy, CD-38 targeting therapy, and elderly patients. Hence, these patients should receive a 4 shot series. [Table: see text]
Comparison of SARS-CoV-2 aerosol emission from patients with Omicron BA.1 or BA.2 subvariant infection
Authors: Yidun Zhang, Jiaming Li, Lina Jiang, Qi Chen, Yingying Fu, Yifei Jin, Zehui Chen, Fei Tang, Xiaohong Zeng, Huixin Wen, Bing Lu, Li Li, Jing Zheng, Zhongyi Wang
Journal: Journal of Infection (2022)
Historic Residential Redlining and Present-day Diabetes Mortality and Years of Life Lost: The Persistence of Structural Racism
Authors: Sebastian Linde, Rebekah J. Walker, Jennifer A. Campbell, Leonard E. Egede
Journal: Diabetes Care (2022)

OBJECTIVE The association between structural racism, as captured by historic residential redlining practices under the Home Owners’ Loan Corporation (HOLC), and present-day diabetes mortality, and years of life lost (YLL), remains unknown. RESEARCH DESIGN AND METHODS Age-standardized mortality and YLL data were combined with historic HOLC redlining data for the city of Seattle, WA (a sample of 109 census tract–level observations) for each of the years 1990 through 2014 (25 years). Spatial autoregressive regression analyses were used for assessment of the association between an area’s historic HOLC redlining score and diabetes (and all-cause) mortality and YLL. RESULTS Spatial autoregressive model estimates indicate that an area’s HOLC redlining score explains 45%–56% of the variation in the census tract–level diabetes mortality rate and 51%–60% of the variation in the census tract diabetes YLL rate between the years of 1990 and 2014. For 2014, estimates indicate that areas with a unit-higher HOLC grade are associated with 53.7% (95% CI 43.3–64.9; P &amp;lt; 0.01) higher diabetes mortality rates and 66.5% (53.7–80.4; P &amp;lt; 0.01) higher diabetes YLL rate. Magnitudes of marginal effects were consistently larger for diabetes than for all-cause outcomes. CONCLUSIONS Results indicate sizable, and statistically significant, associations between historic redlining practices and present-day diabetes mortality and YLL rates. In addition, the persistence of these associations across the 1990–2014 period highlight a need for targeted action to undo the impact of historical redlining on current health.
Lisocabtagene maraleucel (liso-cel) as second-line (2L) treatment (tx) for R/R large B-cell lymphoma (LBCL) in patients (pt) not intended for hematopoietic stem cell transplantation (HSCT): Patient-reported outcomes (PRO) from the phase 2 PILOT study.
Authors: Leo I. Gordon, Daanish Hoda, Ling Shi, Shien Guo, Fei Fei Liu, Julia Braverman, Ronald L. Dubowy, Lily Peng, Alison Sehgal
Journal: Journal of Clinical Oncology (2022)

6567 Background: PILOT (NCT03483103) evaluated liso-cel, an autologous, CD19-directed, CAR T cell product, as 2L tx in pts with R/R LBCL not intended for HSCT. We analyzed changes in health-related quality of life (QOL) with respect to functioning and symptoms in PILOT. Methods: Adults with R/R LBCL after first-line tx were eligible. Pts were deemed not candidates for high-dose chemotherapy and HSCT by their physician and met ≥ 1 frailty criteria: age ≥ 70 yr, ECOG PS = 2, DLCO ≤ 60%, LVEF &lt; 50%, CrCl &lt; 60 mL/min, or ALT/AST &gt; 2 × ULN. Pts completed EORTC QLQ-C30, FACT-LymS, and EQ-5D-5L (health utility index [HUI] and VAS) at screening (baseline [BL]), pre-tx (within 7 days before lymphodepletion), preinfusion on day of liso-cel infusion (Day 1), post-tx on Days 29, 60, 90, 180, 270, 365, 545, and 730/end of study, or at PD. The PRO-evaluable set included all pts with BL and ≥ 1 post-BL assessments. Linear mixed-effects models for repeated measures assessed the least squares (LS) mean change from BL for visits with ≥ 10 pts. Meaningful change from BL was calculated using responder definitions (in points): 10 for EORTC QLQ-C30, 3 for FACT-LymS, 0.08 for EQ-5D-5L HUI, and 7 for EQ-VAS. Results: Among the PRO-evaluable set, completion rates were high (≥ 80%) across most visits for all measures. For EORTC QLQ-C30, mean BL fatigue was meaningfully worse than in a general noncancer population (difference of &gt; 10 points). Overall LS mean changes through Day 545 showed significant improvements in EORTC QLQ-C30 fatigue and pain, FACT-LymS, and EQ-VAS (Table). Improvement for lymphoma symptoms was also clinically meaningful. Fatigue improvement was clinically meaningful with a more sensitive minimal important difference of 4 (Cocks et al, 2012). Significant worsening was not observed for any outcome. In individual patient-level analysis, 70% of pts demonstrated meaningful improvement in FACT-LymS at month 6. Conclusions: Liso-cel meaningfully improved fatigue and FACT-LymS scores without negatively impacting other QOL measures. These data support the clinical evidence of liso-cel as a potential new 2L tx in pts with R/R LBCL not intended for HSCT. Clinical trial information: NCT03483103. [Table: see text]
Neoadjuvant therapy with concurrent anthracyclines and taxanes in Her2-negative breast cancer (HNBC): TAC legacy.
Authors: Victoria García Samblás, Morales Pancorbo David, Isabel Aragon Manrique, Juan L. Bayo
Journal: Journal of Clinical Oncology (2022)

e12629 Background: Adyuvant therapy with Concurrent docetaxel-adriamycin-cyclophosphamide (TAC) increases overall survival in positive node breast cancer. However it is associated with an increased risk of infection and cardiotoxicity. Switching to epirubicin (TEC) and adding Filgrastim prophylaxis (GCSF) could be an useful and safe option in the neoadjuvant setting. Methods: We reviewed the efficacy and safety of neoadjuvant regimen TEC x 6 cycles(c) and GCSF in HNBC. Kaplan–Meier, Cox regression and binary logistic regression were performed to analyze survival prognostic factors, pathological complete response rate (pCR) and serious adverse events. Results: From 2015 to 2021, 204 patients (pt) and 1125 cycles were registered. Median follow-up of 39.4 months. Median age 48 years (SD 8.3), stage II to IIIC (35% IIB), 64% were positive node and 25% Triple Negative(TN) tumors. A median dose of 90% (87.9-93.4) was administered, 93% with a cumulative dose higher than 66% (equivalent to 4 c). Radiologic response in 75% pt. 16.3% pt achieved pCR (3.2% in LumA, 15% in LumB and 35% in TN tumors). OR 4.98 (2.18-11.35) for TN and OR 0.94 (0.89-0.99) for older p&lt;0.05. No relapses were detected in TN patients with PCR. PCR was non-inferior in pt who received 66% of planned dose (OR 1.3, p=0.76) and was higher in LumB than LumA, OR 5.2 (1.13- 24.61), p &lt;0.05. Lymphadenectomy was avoided in 29.2% of patients with affected node at baseline. 3 years (y) relapse free (F) survival (S) of 86.1% (91-80%), better prognosis in stage II HR 0.29 (0.14-0.58) and older HR 0.93 (0.89-0.98), p&lt; 0.005. 3y overall FS of 89% (93-84%), worse prognosis in TN with HR 3.48 (1.37-8.84). Lower risk in stage II with HR 0.31 (0.13-0.75) and in Pegfilgastrim with HR 0.14 (0.03-0.67), p&lt;0.05. Hospital admissions in 24% for any cause. Older age (OR 1.05, p=0.01). 21% neutropenia G3/4. Infections in 17.2% of pt. Febril neutropenia in 18.1%, no related to age (p=0.5) or pegfilgrastim Vs filgrastim (p=0.99). Asthenia 17%, colitis 6% and thrombosis in 2%. No cardiacs events were reported. Conclusions: TEC is effective in the neoadjuvant setting of HNBC. It has similar pCR and survivall to those reported in meta-analysis. GCSF facilitates treatment compliance but the risk of neutropenia and admissions are still present. A lower cumulative dose could be enough to achieve the same results. Stage III and TN have shown a worse prognosis.
Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS
Authors: Aniket S. Rali, Sagar Ranka, Amy Butcher, Zubair Shah, Joseph E. Tonna, Marc M. Anders, Marshal D. Brinkley, Hasan Siddiqi, Lynn Punnoose, Mark Wigger, Suzanne B. Sacks, Dawn Pedrotty, Henry Ooi, Matthew D. Bacchetta, Jordan Hoffman, William McMaster, Keki Balsara, Ashish S. Shah, Jonathan N. Menachem, Kelly H. Schlendorf, JoAnn Lindenfeld, Sandip K. Zalawadiya
Journal: JACC Heart Failure (2022)
Accuracy and Completeness of Intermediate-Level Nursery Descriptions on Hospital Websites
Authors: David C. Goodman, Timothy J. Price, David Braun
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Birth at hospitals with an appropriate level of neonatal intensive care units is associated with better neonatal outcomes. The primary sources for information about hospital neonatal unit levels for prospective parents, referring physicians, and the public are hospital websites, but the accuracy of neonatal unit capacity is unclear. <h3>Objective</h3> To determine if hospital websites accurately report the capabilities of intermediate (ie, level II) units, which are intended for care of newborns with low to moderate illness levels or the stabilization of newborns prior to transfer. <h3>Design, Setting, and Participants</h3> This cross-sectional study compared descriptions of level II unit capabilities on hospital web pages in 10 large states with their respective state-level designation. Analyzed units were located in the 10 states with the highest number of live births in 2019 (excluding states with no level II regulations) and had active websites as of May 2021. <h3>Main Outcomes and Measures</h3> Hospital websites were assessed for whether there was any mention of the unit, the description of the unit was provided, the unit was identified as a level III or both levels II and III, the terms "neonatal intensive care unit" or "NICU" were used without indicating limits in care available or newborn acuity, or the unit was claimed to provide the most advanced level of care. <h3>Results</h3> A total 28 states had no regulation of nursery unit levels; in the 10 large, regulated states, web descriptions of level II units were incomplete for 39.2% of hospitals (95% CI, 33.3%-45.3%) and inaccurate for 24.6% (95% CI, 19.6%-30.2%). Within incomplete descriptions, 2.6% (95% CI, 1.1%-5.3%) of hospitals did not mention an advanced care unit and 22.0% (95% CI, 17.2%-27.5%) identified a level II unit without providing further description. Within inaccurate descriptions, 25.4% (95% CI, 20.3%-31.0%) of hospitals described the unit as a "neonatal intensive care unit" or "NICU" without any qualification and 9.3% (95% CI, 6.3%-13.5%) claimed that the unit provided the most advanced neonatal care or care to the sickest newborns; 3.0% of hospitals (95% CI, 1.3%-6.0%) stated that their unit was level III and 1.5% (95% CI, 0.4%-3.8%) as level II and III. Across states there was substantial variation in rates of incompleteness and inaccuracy. <h3>Conclusions and Relevance</h3> Incomplete and inaccurate hospital web descriptions of intermediate newborn care units are common. These deficits can mislead parents, clinicians, and the public about the appropriateness of a hospital for sick newborns, which raises important ethical questions.
Real-world use of mogamulizumab among patients with mycosis fungoides and Sézary syndrome before and during COVID-19 in the United States.
Authors: Yang Zhao, Jackson Tang, Huanxue Zhou, Takeshi Takahashi, Takanobu Nomura, Eslie Dennis, Ahmad Sami Halwani
Journal: Journal of Clinical Oncology (2022)

e19575 Background: Per label, mogamulizumab (Moga) is administered on days 1, 8, 15, and 22 of the first 28-day cycle (loading) and on days 1 and 15 of each subsequent cycle (maintenance) for adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after ≥1 prior systemic therapy. During the COVID-19 pandemic, professional organizations suggested dosing intervals for systemic cancer therapies be extended to limit in-person visits. This study examined the real-world use of Moga before and during the COVID-19 pandemic in the United States. Methods: Using the Symphony Health Solutions database, adults with ≥1 diagnosis (dx) of MF or SS (ICD-10 CM: C84.0x or C84.1x) and ≥1 Moga claim during 10/1/2018-5/6/2021 were identified. Within the MF (no SS dx) and SS (any SS dx) cohorts, patients were divided into 2 subgroups based on their Moga initiation date: 10/1/2018-3/31/2020 (pre COVID-19) and 4/1/2020-5/6/2021 (COVID-19). Patient characteristics and dosing intervals between Moga doses 1-4 (loading) and between subsequent doses (maintenance) were examined. Results: Overall, 154 MF and 204 SS patients initiated Moga during the study period (mean age: 66.8 and 69.2 years; male: 64% and 55%, respectively). In the MF cohort, 98 and 56 patients were in the “pre COVID-19” and “COVID-19” subgroups. The mean dosing interval was shorter among patients in the “COVID-19” subgroup for both the loading (9.1 vs. 13.2 days) and maintenance doses (15.2 vs. 16.1 days) (Table). In the SS cohort, 121 and 83 patients were in the “pre COVID-19” and “COVID-19” subgroups. Mean loading (9.0 vs. 11.1 days) and maintenance (15.0 vs. 16.8 days) dosing intervals were shorter for patients included in the “COVID-19” subgroup. Conclusions: Among MF and SS patients, dosing intervals for Moga in loading and maintenance were not extended during the 1 st year of the COVID-19 compared to pre COVID-19. There was a trend towards closer concordance with the label during COVID-19.[Table: see text]